Lori Cartwright is more than her cancer. She’s a mother and grandmother; a partner; an employee; a friend.
From a holistic perspective, treating Cartwright’s cancer meant doing more than attacking the rogue cells. The approach to her ovarian cancer first diagnosed in 2018 required addressing her anxiety and depression that has been exacting its own toll.
“Cancer will break you,” Cartwright said. “It will break you down … If you let your mental (health) go down … you’re just going to be worthless.”
In May 2021, Rochester Regional Health’s Lipson Cancer Center began its Collaborative Care Therapy program to provide support for people with depression or anxiety that may be exacerbated as part of their cancer care. Licensed master’s level social workers are onsite to counsel patients on their diagnoses and provide coping strategies for other troubling aspects of their lives.
Cartwright joined the program last year when she found out that, after three years of remission, her cancer had spread to her colon.
“We all need somebody to talk to,” Cartwright said. “You know sometimes talking to your significant other or your friend just doesn’t do it. They don’t know what to say. They don’t know what to do because they love you.”
That’s why, Cartwright said, it has been a relief to work with Lauren Burling, supervisor of the program. Cartwright said that having Burling to talk to has taken the burden off her family and lets her six grandkids know her simply as “Yia-yia,” which is the Greek term for grandmother.
“Just knowing that I have her there — she’s like in my back pocket. She’s somebody that I can talk to about literally anything and she finds different ways for you to deal with things to cope.”
The Collaborative Care model was developed in the 1990s at the University of Washington as a way for primary care practices to provide services to patients living with anxiety and depression.
Much of the research on the program’s effectiveness has been done in primary care settings. However, a study from 2008-2011 of 500 patients with depression and cancer at three cancer centers in Scotland showed that more than 60% improved in the collaborative care arm, compared to 17% in usual care. Patients in Collaborative Care also reported less fatigue, pain, anxiety, and better quality of life.
The New York state Office of Mental Health, along with the AIMS Center at the University of Washington, has funded a project to help primary care residents learn team-based care to treat mental health conditions.
According to Rochester Regional, it the first cancer center in the area to use the University of Washington model. However, other centers could be employing some type of holistic approach to address the emotional needs of patients undergoing treatment.
RRH has enrolled 753 cancer patients in the approximately 18 months it has offered collaborative care. The program began as a way for the cancer center to offer behavioral health services. The services are billed through insurance and patients are charged a monthly copay, which covers multiple visits during that time.
Patients are assessed for their risk of depression or anxiety in the context of their cancer care, Burling said. The screening tool identifies the difference between patients adjusting within norms to their diagnosis as opposed to individuals who are having difficulty managing their day-to-day activities because their cancer diagnosis is compounded by anxiety or depression.
“Somebody either expresses that they’re struggling and they want to get into a counseling program, a provider notices they’re struggling and refers them or we are able to identify through some of these screening measures in our cancer setting, who may be at a higher risk for depression or anxiety,” she said.
Dr. Robin Reid has worked as a medical oncologist/hematologist with RRH for several years but was not part of Cartwright’s team. She said she enthusiastically supported the Collaborative Care Therapy program.
“We see our patients struggling with their diagnosis and struggling with the treatment and the existential effects of it,” she said. “As a physician, we try to treat the whole patient in front of us, and this is another tool that I think is very useful to support them through their treatment. Not only treating the cancer and then treating the physical side effects of the chemotherapy, but also to try to support them through the mental health portion of it.”
Reid said most patients have been receptive to seeing a counselor. Those who hesitated may have believed they were showing a weakness. “With further discussion, they’re like, yeah, this might be good to learn more about.”
Patients are accepted for year, during which time they can have in-person, video or phone visits.
“Behavioral health access is incredibly limited in our country everywhere, and Rochester isn’t an exception,” Burling said. “The most important thing for someone who’s experiencing a mood concern like depression or anxiety in the context of a cancer diagnosis is to get them support without them needing to go to a new location, a new clinic, a new provider.
Cartwright’s cancer journey began when her mother was diagnosed with stage four ovarian cancer. Cartwright learned from genetic testing that she had a mutation that increased risk for breast and ovarian cancer. She learned she had ovarian cancer from a biopsy taken during her preventive hysterectomy.
A couple years later, blood work showed an increase in a marker for cancer, and Cartwright went to an oncologist in Clifton Springs. She filled out a screening form to gauge her anxiety and depression and said by the time she was in her car driving home, Burling was on the phone.
“I kind of knew it because I have anxiety and I’ve been dealing with a lot of depression, so I knew what was coming,” Cartwright said. “She’s like, ‘you don’t have to talk to me if you don’t want to.’ I thought to myself, ‘if you don’t take it, you’re going to be in a really big mess. You know yourself, so just accept into your life,’ and I did.”
Cartwright said Burling has figuratively been a life saver.
“I’ve got to say that she saved a lot of days to where I wasn’t being mean to other people. I actually could put a smile on my face just knowing that she was there because I can’t say that everything is going to be OK because ain’t nothing going to be OK when you’re fighting cancer. She just made it easier.”
Patti Singer is a freelance writer in Rochester. Contact her at [email protected]